Provider First Line Business Practice Location Address:
THE GYM
Provider Second Line Business Practice Location Address:
1005 ID-13
Provider Business Practice Location Address City Name:
GRANGEVILLE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-790-8759
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/01/2022